Some 40 years ago, cervical cancer was the most common cause of cancer deaths among women. That changed, largely because of the Pap smear, now part of a routine well-woman exam.
The Pap smear, sometimes called a Pap test, is a screening tool for precancerous cells that may become cancerous. Detecting precancerous — or even cancerous — cells early in their development means a greater chance of treating them effectively.
Board-certified OB/GYN Dr. Hany H Ahmed specializes in the management of abnormal Pap smear results for his patients in Houston, Texas. An abnormal result doesn’t necessarily mean you have cervical cancer.
Here, Dr. Ahmed explains what “abnormal” really means and what he can do about the problem.
Pap smear basics
A Pap smear is an in-office procedure that only takes 10-20 minutes. Dr. Ahmed performs this test every three years, starting when a woman turns 21.
For women over 30, he may also test for the human papillomavirus (HPV). It’s the most common sexually transmitted infection (STI) and is associated with cervical cancer.
With a Pap smear, you lie back on the exam table with your heels in stirrups. Dr. Ahmed inserts a thin, metal tool called a speculum into your vagina. When he opens the speculum, the vaginal walls widen, allowing him to see the cervix, the opening at the lower end of the uterus.
Using a swab, he collects a sample of the cervical cells, which he sends to a lab for analysis.
What does an abnormal result mean?
The results of a Pap smear can come back negative, positive, or abnormal.
A negative result means that no cancerous, precancerous, or otherwise abnormal cells were detected. Abnormal results most often indicate cervical cell changes caused by HPV, but there are other potential causes.
Atypical squamous cells of undetermined significance (ASCUS)
Squamous cells are thin, flat cells that grow on the cervix, and ASCUS means the cells aren’t typical of healthy cells. Dr. Ahmed tests them to determine if HPV is present. If this test is negative, he may repeat it or adopt a wait-and-see approach.
Squamous intraepithelial lesions
These lesions can be precancerous. Doctors classify them as low grade or high grade to describe their appearance.
Low-grade lesions may be a sign of an HPV infection, or they might not turn cancerous for many years. If they’re high-grade, they can become cancerous much sooner. In both cases, Dr. Ahmed follows up with more tests to understand the situation.
Atypical glandular cells
Glandular cells are found in the opening of the cervix and inside the uterus, and they serve to produce mucus. If these cells are abnormal, they may be precancerous or even cancerous, so Dr. Ahmed follows up with more tests.
Squamous cell cancer or adenocarcinoma cells
If your results show highly atypical cells, and Dr. Ahmed is almost certain they're cancerous, he follows up with additional tests while also treating the cancer before it can develop further.
Following up on an abnormal Pap smear
The tests Dr. Ahmed uses depend on how atypical your cervical cells are. If they’re just slightly abnormal, he may recommend a second Pap smear, either immediately or after a few months, and/or an HPV test if he didn’t do one before. He may also order a colposcopy and a biopsy.
For the colposcopy, he inserts a speculum into your vagina and then a colposcope, a long, thin tube with a magnifying lens and light. This lets him see the cervix and its cells in more detail than during the Pap test. He swabs the cervix with vinegar to highlight any suspicious areas.
If the doctor finds patches that look precancerous or cancerous, he takes a biopsy, a small tissue sample. He sends this to a lab for further testing. The results you get from this test are far more detailed than those from a Pap smear.
If the tests show any cells that warrant attention, Dr. Ahmed treats them with cryotherapy. He uses a specialized instrument to freeze the abnormal tissue. It dies off, and the cells are eventually eliminated from your body so they can’t harm you.
If your Pap smear comes back abnormal, there’s a good chance the cells aren’t cancerous, but it’s best to make sure. To learn more, or to schedule a Pap smear with Dr. Ahmed, call the office at 713-489-3348 or schedule online.